Children and mobile media: Strategies for pediatric practice

Rich-Mobile-Media-Boston Children's Thriving blogThere is substantial scientific evidence from multiple disciplines that the mobile media children use and how they use them influence their development and their physical, mental and social health. Among areas of concern in children are: risk-taking, sexual behavior, alcohol, tobacco and drug use, violence, obesity, disordered eating, learning, sleep and social connectedness.

The American Academy of Pediatrics has been issuing policy statements on the health effects of media for over 30 years and observant pediatricians recognize that their patients are affected. But a lack of clear diagnostic criteria and therapeutic guidelines combined with increasing demands on ever-shorter patient visits have made it difficult to prioritize and integrate media-related anticipatory guidance, diagnosis and treatment into standard of care pediatric practice.

While pediatric concerns surrounding the effects of screen viewing on obesity, anxiety, violence and substance use persist from the television era, the influences of media on children’s health and development have exponentially increased with the ubiquity of mobile digital devices. Interactive smartphones and tablets have transformed the lifestyles, behaviors, communication and connectedness of children and adolescents. Toddlers are placated with screens during family meals. School children spend countless hours video gaming. Adolescents look down when they talk because they are more accustomed to texting than face-to-face communication.

‘Media are like the air they breathe’

We clinicians can no longer afford to ignore screens as outside of our clinical responsibilities – or even to recommend restricting or avoiding media as vectors of harm.When tweens are averaging six hours, and adolescents nearly nine hours a day with media, and 92 percent of youth online every day and 24 percent on “almost constantly,” we clinicians can no longer afford to ignore screens as outside of our clinical responsibilities – or even to recommend restricting or avoiding media as vectors of harm. Screens are ever-present in young people’s lives, used for education, communication and entertainment. Media are like the air they breathe. We must reframe media in our clinical practice as a powerful environmental health influence. Just as we respond to air quality concerns by improving home ventilation and advocating for clean energy, rather than restricting breathing, we must help our patients and families become aware that they are changed by the media they use and how they use them – and guide them to use media mindfully.

In my clinical practice at the Adolescent/Young Adult Clinic, I am seeing increasing numbers of patients who have become so deeply involved in media that their sleep, school performance, activity, weight and mental health have suffered. My psychiatric colleagues and I have developed specialized expertise in dealing with children and teens who have become disabled in their daily lives by their media use. We have treated depression resulting from cyberbullying, anxiety related to social media use, sleep deprivation and school dropout due to gaming, sexting, catfishing, sexual and social dysfunction as a result of pornography use, even attempted suicides by youth whose online access was taken away.

While colloquially called “internet addiction” and non-specifically termed “internet gaming disorder” by the DSM-5, our experience shows these terms to be both inaccurate and stigmatizing, resulting in growing problems going unrecognized in young people who do not look like “addicts”. Describing compulsive use of social media, online gaming, pornography and information-seeking/binge video viewing, as problematic interactive media use (PIMU), we are building a Center for Interactive Media And Internet Disorders (CIMAID, appropriately pronounced sim-aid). We are creating an evidence base of diagnostic criteria, therapeutic strategies and outcomes data with which to characterize these syndromes and develop evidence-based treatment protocols.

‘Educate and empower’: A toolkit for clinicians

To expand these efforts beyond the walls of Boston Children’s and to educate and empower fellow clinicians to diagnose and treat young people struggling with media-related health issues, including PIMU, the Center on Media and Child Health (CMCH), with generous support from Harvard Pilgrim Health Care, has developed a Clinician Toolkit. Designed to seamlessly integrate awareness of and strategies for addressing health problems of the Digital Age into standard of pediatric care, the toolkit treats media exposure as an environmental health concern and provides research-based tools for addressing physical, mental and social health issues that have been linked to media use.

Because so much of pediatric care is overseeing the development of healthy children, a key component of the health maintenance visit is anticipatory guidance; helping parents and their children become aware of potential challenges and choose healthy options in the next stage of development. The toolkit provides research-based anticipatory guidance for six age- and stage-based strategies for healthy, developmentally-optimal media use by infants through young adults and a video demonstration of how to integrate media awareness into a clinical appointment. A screening tool for patients and parents completed prior to physician contact reveals the child or adolescent’s media use, and the toolkit provides fundamental approaches to diagnosing common media-related health concerns.

Finally, CMCH is planning a 2018 summer institute for pediatric and psychiatric clinicians, psychologists, social workers and teachers in which they will learn the problems and potentials of growing up in the Digital Age and develop toolkits individualized to their practice.

Shifting to an evidence-based action plan

By developing strategies and tools for preventing, recognizing and treating health problems that have been associated with media, CMCH has provided the matrix for shifting from a values-based perspective on children’s media use toward an evidence-based action plan for promoting our individual and population health. But reframing is not enough – and CMCH cannot do it all. We are in this together. We depend on crowdsourcing your potential as acute observers and well-trained scientific minds, with years of clinical experience and a deep commitment to the well-being of children, to use the CMCH Clinician Toolkit, adapt the tools to fit individual and practical needs, and provide feedback in order to constantly evolve the tools to meet the current and future needs of patients and their families.

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About the author: Michael Rich, MD, MPH, FAAP, FSAHM, is the founder and director of the Center on Media and Child Health at Boston Children’s Hospital and associate professor at Harvard Medical School and Harvard School of Public Health. He is the recipient of the AAP’s Holroyd-Sherry Award and the SAHM New Investigator Award, has developed media-based research methodologies and authored numerous papers and AAP policy statements, testified to the United States Congress and makes regular national press appearances.